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Friday, July 16, 2010

Why my son is intact

I've mentioned before, briefly, that I oppose circumcision, and I received some questions about my opinion. Now that I've done even more research, I think it's time to explain my reasons. I tried to gather the best research I could find, but there is a whole lot more on this topic than I am providing here.

1. There isn't a good reason to do it. I consider the burden of proof to be on those who favor circumcision, because the "default" option is generally inaction. Further down I'll answer the most common "reasons" that people give in favor of circumcision.

2. I am not Jewish. Circumcision was mandated by God as a sign of the covenant -- something that was definitely a sacrifice -- and we are told in the New Testament that it is not necessary. (N.B. Circumcision as practiced before the time of Christ was also much less drastic. Thousands of boys would have died from blood loss and infection if they had been circumcised according to the current method without our current medical care.)

3. The Catholic Church seems to oppose circumcision. For example, from the Council of Florence in 1439: "Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation." Besides, the Church teaches the importance of bodily integrity: as long as an organ or body part is functioning properly, it should not be damaged or removed. This is the same as the argument against sterilization. For more, read this article.

4. God does not make mistakes. Every part of the body has a function and a reason for existing. We could all live with one finger cut off, but we don't do it because the finger still has a function. A couple generations ago, children's tonsils were routinely removed because they looked like they might be a problem. Now, we no longer do this, because it's been discovered that tonsils have an immunological role, and it's better to have your tonsils if they are not actually infected. Although people are still puzzling over the role of the appendix (some interesting studies on this have been published, though), we do not proactively remove the appendix. First, it might have some use we don't know about; and second, we do not put people through surgery unless there is a clear benefit to be gained.

5. Circumcision is inhumane. It is normally done on infants without anesthesia. (It is not considered safe to use a general anesthetic, and a local anesthetic is not completely effective and so is not usually used.) The argument against this is, "Well, he won't remember it." I don't think that matters at all. If it did, I wouldn't be so careful with the diaper pins -- because, hey, if I accidentally stab the kid with a pin, it doesn't matter because he won't remember it! Painful experiments on infants are considered unethical. (Sadly, this has not always been the case: extensive experiments have been carried out on infants in the past, to determine whether they could feel pain. The verdict is that they feel pain as intensely or more intensely than adults. But I think it's horrible that they went around poking newborns with pins in order to find this out.)

A few generations ago, "twilight sleep" was a common anesthesia for birth. Women were told that they would sleep through the birth and experience no pain. In fact, they experienced extreme pain and a loss of control -- they just remembered none of it. Women were blindfolded and strapped to beds in order to give birth. Later this, too, began to be considered unethical.

6. I don't believe I have the right to make this decision for my son. As I pondered the question, I realized that I have no idea what he might want when he is older. I know circumcised and intact men who are happy with the choice their parents made for them. But my son might not be. Whichever decision I made for him, he might want me to have made the other one. However, if I had him circumcised, he would not be able to undo it. If I left him as he is, he could have it done later if he wanted. So I picked the option that he would be able to change later. (Circumcision is less painful when done on adults, because they can be anesthetized, and also because the foreskin has retracted and doesn't have to be peeled off.)

7. Circumcision is considered by the American Medical Association and the American Academy of Pediatrics to be non-therapeutic. Neither association -- in fact, no accepted medical association -- recommends the procedure. Instead, they say it is a matter of personal choice, with no medical reason to recommend it.

8. Circumcision removes around 20,000 nerve endings in a very sensitive place. If my son gets married, he might want those later. The foreskin also has a protective role. It's not a worthless bit of skin, but a complex and useful mucous membrane. (This link has more, but there's one picture which women might want to avoid looking at. Sorry about that.)

9. 89% of women who have experienced both prefer an uncircumcised partner, according to one study.

10. Circumcision of an infant can result in serious injury, infection, or hemorrhage -- which may lead to death. It only takes 2 ounces of blood loss for a newborn to bleed to death -- an amount easily absorbed and hidden by a diaper. There are a lot of blood vessels in this area, and all it takes is for a clamp to slip or an artery to reopen to begin a hemorrhage. Children of both sexes under the age of 10 are more likely to die from male infant circumcision than from choking. I don't give my baby tiny toys he could choke on; I'm certainly not going to risk his life voluntarily. More on the risks of circumcision.

11. Circumcision interferes with breastfeeding. (And you all know how I feel about that!) Frequently an infant who was nursing well before circumcision will come back glassy-eyed and unresponsive. They often fall into a coma-like sleep with no REM (which is not natural or healthy for an infant anyway) and can't be awakened to nurse. When I told the lactation consultant that my baby was not going to be circumcised, she breathed a huge sigh of relief. Apparently she has a very hard time getting breastfeeding established with a circumcised infant.

And a response to the supposed benefits of circumcision:

1. Circumcision was popularized as a way to discourage masturbation. In fact it has the opposite effect, by a large margin.

2. Circumcision is supposed to prevent urinary tract infections (UTIs). In fact, the foreskin has a protective effect against UTIs except in the first year of life. At that time UTIs are slightly more common in intact infant boys, but the difference (1.26%) is not statistically significant. Also, breastfed infants only have 38% of the UTIs of formula-fed infants. So, if you want to protect your son from UTIs, breastfeeding is a much more effective route. Also, girls are at least four times more likely to get a UTI than boys (intact or circumcised). Yet circumcision of girls -- a very similar procedure -- is not commonly done in this country. In fact, it is illegal. UTIs can be easily treated with a course of antibiotics or even a jug of cranberry juice. It is not an infection which requires surgery to cure or prevent.

3. Circumcision does not prevent STDs. One, rather unscientific study in Africa showed male-to-female transmission of HIV was somewhat reduced if the men were circumcised. (Note: a commenter informs me that subsequent studies said the opposite.) However, transmission of gonorrhea and clamydia seems to increase in circumcised populations. Europeans aren't known for being more moral than Americans, just less likely to be circumcised, but their rates of STDs are much lower. In any event, I doubt any sex-ed teacher is ever going to say, "Circumcised boys are protected from STDs, so you can ignore all this and go sleep around without a condom!" No, risky sex is risky sex, and no one should get a false sense of security just because they are circumcised.

4. Intact boys aren't at much risk of getting teased or looking different, because infant circumcision rates in American have now dropped below 50%.

5. Hygiene for an intact boy is quite simple. Before natural retraction (which happens at an average of 10 years old) nothing need be done; afterward the boy can retract his foreskin and rinse with water. That's it. If the parents are embarrassed to explain this to him, they can get him a book on hygiene which will let him know. There are many much easier ways to deal with this issue than cutting off a bodily organ.

6. Some people circumcise their sons "so it won't have to be done later." In fact, 10% of boys circumcised as infants will have to have their circumcision re-done later. 1% of intact boys will be told (rightly or wrongly) that they need to be circumcised later due to a medical condition. So, you have a better chance of avoiding unneeded surgery by never getting it done in the first place. (Source.)

That's all I have to say on the topic. I have avoided graphic descriptions of what is done in a circumcision because I wanted to work your reason rather than your emotions, and the details are frankly horrifying. A video would be more shocking still -- many nurses refuse to participate in circumcisions after having seen one, because they are convinced of its cruelty. If you're considering circumcising your child, I would encourage watching such a video before making up your mind... if you don't have the strength to watch it, how could you force your child to undergo it? But for those who do not plan to circumcise or do not have children, I wouldn't advise watching those videos, because they are rather intense. (I did not watch the videos because the descriptions alone brought me near to tears.)

Feel free to share this post however you like -- I tried to gather the reasons I found the most cogent to save people the trouble of tracking down all the facts themselves, as I did.

22 comments:

I never actually thought about this issue (because I've never had to) but this is a great post. It makes your case very reasonably (as you hoped it would) and it brings up points even I didn't know were in the debate. May you get a lot of hits for this one! =)

Haha, I hope so. It's a topic I'd like more people to think harder about before making the decision. The nurse asked me *while I was in labor* whether we were going to have him circumcised. I imagine some people get to this point without knowing what they're going to do, and make a hasty, ill-considered decision.

We kind of have "the worst of both worlds" in the Philippines. Circumcision is considered a rite of passage for preteen boys. Lots of boys get the operation done the summer before sixth grade (or thereabouts) and some doctors even work pro bono for mass circumcisions for the poor. And all the boys go through it because they think they have to (or in the case of my still-traumatised brother, because my stepfather wanted him to have that "valuable" experience); the pressure is really much worse. Nobody talks about it at all, and the general belief is still that uncircumcised genitals are less hygienic--not just for the boys, but also for the women they will eventually marry.

Oh, dear! I know that is the case in many countries, particularly in Africa. (Female circumcision is also generally a rite of passage rather than something done to infants.) That would be so traumatic!

I don't suppose I need to say that I've never seen the slightest evidence that circumcised men are less likely to transmit infections to their wives. Except for the one HIV study, I don't believe there is any.

More parents need to think of your Item 6. I am a son who was circumcised at birth and I really wish I had not been circumcised. I dislike my circumcision so much that I am restoring my foreskin to undo some of the damage from my circumcision. The choice to have part of my sex organ removed should have been my choice, and, it would be a choice that I would never take. I would have preferred to keep my body whole.

One of the very best posts ever on this subject by a mother. And your message is clear: God / Mother Nature deserves the benefit of the doubt.

You claim that:

* The USA circ rate is now below 50%. I sure hope you are correct, but have not read that elsewhere. I do suspect that boys are more aware that there are two styles of penises, and boys of one style are probably more accepting of the other style. The Great Conversation America has been having about the tip of the penis has probably influenced boy culture at least a bit.

* Circ promotes masturbation. Have never read that before. But I can assure you that masturbation was a running bawdy joke among my baby boom teenage peers who, from what I saw in locker rooms, were 99% circumcised. Hence circ certainly does not extinguish masturbation.

* 89% of women who "have had both" prefer intact. Let me remind you that for a woman to speak to this question requires that she have blatantly disregarded Catholic moral teaching. Condoms eliminate most of the sexual difference between cut and uncut, so she has also practiced unsafe sex.

You have in mind a study done on a limited self-selected sample in Australia or New Zealand. It is very far from definitive.

I have read thousands of posts in dozens of forums, answering the question "North American and Australian ladies, do you prefer cut or uncut?" I submit that the answers come under 4 headings:

1. She finds intact distasteful, mainly because she thinks it unsanitary.

2. She prefers cut, but will accept intact, especially if the intact man is interesting in other ways.

3. She doesn't care, or claims that she does not even notice this aspect of male intimate anatomy.

4. She prefers intact. The most eloquent posts come under this heading. SOme women say that their discovery of intact was a turning point in their life journey of sexual discovery. A few women say that their sex lives with cut men were frought with chronic pain, drybess, and inability to climax, and that things are wonderful with intact partners.

Someone should interview a stratified random sample of several thousand Canadian and Australian women, with the first question asked "have you had vaginal intercourse with both circumcised and uncircumcised men, in both cases without a condom, and are you willing to talk about the difference?" If she says no, the interview ends. I am not betting I will see such a study in my lifetime.

Restoring Tally: Thanks for the link! I know the original study on HIV and circumcision was flawed for many reasons, and I'm not surprised to see another study saying the opposite.

Anonymous, unfortunately I don't know the method used in the study on women's preference, or what country/countries it surveyed. I must point out that good Catholics might participate in this study, if, for instance, they were widowed the first time around. (I, however, couldn't. Only married once, and besides, I chose not to talk specifically about my own experience in this post.) Most likely a really accurate and unbiased study has not been done. After all, I imagine most women would prefer whatever was most familiar to them, or whatever the person they loved most had. How could you really get an objective study on the issue?

N.B. I'm going to edit this article a bit because I've realized there are more things to add!

Thanks for posting this! My brother is a medical student and has seen all sorts of things, but he was unable to watch a video of circumcision because it was so brutal. I think most people don't realize what the operation actually entails and how much it hurts the baby.

I didn't know that circumcision was less drastic in Old Testament times; that makes me feel better about the Old Covenant...

I'm embarrassed to say that I knew less than half of this information. It truly is a crime that this information is not promulgated as it should be. Thank you, Sheila, for the clarity your research has given me.

My wife and I were talking about this issue recently after a friend mentioned she was considering not circumcising if she has a boy. My personal experience was not being circumcised as an infant. The first time I pulled my foreskin back to clean under it in the bath tub, my foreskin swelled up and wouldn’t go forward, constricting the head of my penis. We had to go to the emergency room where it took them about fifteen minutes of shots and pulling with forceps to put my foreskin back over the head.

After that trip I was always meticulous abut washing under my foreskin with soap and water, but in college I got a yeast infection under my foreskin which also resulted in tearing the frenulum which attaches to the foreskin. The doctor said that the foreskin creates a moist, warm environment where bacteria can easily grow. I ended up being circumcised in college to prevent any more infections.

That's fine -- after all, it was your choice to do so! Most boys don't have these complications, so it seems fair to wait and see how it turns out. I certainly would not be at all upset or offended if my son later decided to be circumcised.

@Adam, sorry to hear about your problems. It sounds like your parents were not aware that boys and men should not use soap under the foreskin. The tissue under the foreskin is mucous membrane, the same type of tissue that is under your eyelids. Washing mucous membrane with soap has a tendency to dry it out and cause problems.

There is a study that shows washing under the foreskin with soap is a leading cause of recurrent balanitis and infections. In the study, the symptoms were relieved by rinsing under the foreskin with only water and not using soap. Unfortunately, Western society has a cleanliness issue and oftentimes people overwash to the detriment of their health. Chances are, your problems in college were likely caused from overwashing under your foreskin with soap.

Just discovered this. Thank you so much for this informative, well-written post. I'll definitely be using some of your points if and when anyone questions my husband (who is a physician, by the way) and my decision to not circumcise my son.

thank you for this :) I am a Christian, living in a Muslim country and with a Muslim guy, hopefully one day we will get married and I was always thinking that if we had a boy together he would be circumcised - it was not a big deal to my and my only condition was to do it early, very early, and not the way they do it here (my bf was circumcised at the age of 11, I can't even think about it)

my main problem so far was the idea that the kid might not be happy with what we had done at some point, but I thought it wasn't good enough to fight with religion and years and years of tradition, but now I think I will fight a bit more ;)

I just wanted to mention-we had our son circumcised when he was a newborn but we used a new procedure that doesn't involve a scalpel. In fact, he slept through it. They put it on and at the two week check up they take it off and the foreskin comes off with it. So if someone is considering circumcision, there is a different method that's all. Loved the article, it was very informative :)

If you're talking about a Plastibell circumcision, from what I understand, it is no less painful than one done with a scalpel. Some babies do appear to sleep through circumcision, but many believe this is a stress response. The body shuts down in defense. Often the baby is unusually sleepy for a day or two after, unresponsive, and has trouble nursing. So the fact that a baby doesn't cry isn't proof that he isn't fazed by it. Unfortunately, most people don't notice a change in their child because the circumcision is at a day or two old, before they know what their baby was originally like or how much sleep is normal for him.